Best vascular training programs

[Novost]

Hey all,

Gen surg resident here looking to match in a vascular surgery fellowship and was curious about sentiment on the forum regarding which vasc fellowships nationwide are considered excellent training programs while I'm in the process of putting together a list of where to apply. Have also been in touch with staff at my institution but was also curious what sdn community had to offer

Thanks for your time!

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[LucidSplash]

Can you tell

Hey all,

Gen surg resident here looking to match in a vascular surgery fellowship and was curious about sentiment on the forum regarding which vasc fellowships nationwide are considered excellent training programs while I'm in the process of putting together a list of where to apply. Have also been in touch with staff at my institution but was also curious what sdn community had to offer

Thanks for your time!

Can you tell us more about what your professional goals are? Will help with the discussion. A lot depends on your priorities and what you think you want your ultimate practice setting to be. Also if there are specific interests in vascular surgery. You’ll get good training pretty much everywhere, but the answer will be different depending on if you’re gungho about super complex thoracic aortic reconstruction vs limb salvage, for example. Not all places specialize in the same thing. Interested in complex dialysis access? There are programs where vascular doesn’t do most of the access work.

So a little more information/context will be key.

 

[Novost]

Can you tell

Can you tell us more about what your professional goals are? Will help with the discussion. A lot depends on your priorities and what you think you want your ultimate practice setting to be. Also if there are specific interests in vascular surgery. You’ll get good training pretty much everywhere, but the answer will be different depending on if you’re gungho about super complex thoracic aortic reconstruction vs limb salvage, for example. Not all places specialize in the same thing. Interested in complex dialysis access? There are programs where vascular doesn’t do most of the access work.

So a little more information/context will be key.

Absolutely, Thanks for the reply. I actually am a MD/PhD grad with an interest continuing basic science research and incorporating that into my practice (which I know has it's own issues balancing surgical and research careers having worked in basic labs with surgical PIs both for my thesis and residency research time) but my top priority is to seek out programs that have excellent open experience without a loss in exposure to complex endo case volume. Interestingly limb salvage and thoracic aorta recon are an interest of mine. As a fellow I'm sure I'm unlikely to have any time to do basic research so I wanted to ensure solid clinical training rather than choosing a program based off academic notoriety alone.

Thanks again!

 

[cutsman]

I'd like to piggy back on this question. Also coming from GS and interested in Vascular - but there really is a dearth of info online. Plus I'm still figuring out what I'm interested in

Where would you go for the best all-round general vascular/endovascular training?
Where to go to learn open aortic stuff?
Where for complex endovascular stuff?
Any major regional differences to be aware of? I'm located in the West

What would recommend for the senior GS resident to consider when applying? What informed your decision making?

Thanks for being active on this forum - between you and type 2 and mim, its great to read about Vasc life

 

[TypeADissection]

Everything below is just an opinion so take it for what it's worth:

Where would you go for the best all-round general vascular/endovascular training?
- Almost every program will give you this. This isn't a cop out answer, but there are requirements to being a fellowship and so if it is an accredited program, then you're going to be fine for the most part.
- The other thing to consider is your own ability to pull from fellowship what you need in order to be successful. I've had attendings come from big name institutions and suck ass. I've also had those come from lesser name programs and just be absolutely slick. So although the name matters-ish, the more important thing is you and your ability to extract from those two years what you need in order to be successful in independent practice.

Where to go to learn open aortic stuff?
- Caveat: I'm gonna miss some. I just am. This in no way should be interpreted as disrespect.
- The usual suspects come to mind: Cleveland Clinic, U of Florida, UTSW, UPMC, Houston Methodist, Albany.
- The less known: U of Wisconsin, Pennsylvania (not UPenn), Colorado, NYU.

Where for complex endovascular stuff?
- Stanford, Mayo (not sure w/ Oderich leaving for UT Houston but I'm sure they'll continue to crank), UTSW, U of Washington, UNC. Basically anybody who has an IDE.

Any major regional differences to be aware of? I'm located in the West.
- I don't think so. Being on west coast will make it expensive and exhausting to travel to the east coast programs for interviews, although I have no idea how this will work now with COVID.

What would recommend for the senior GS resident to consider when applying? What informed your decision making?
- I think it's important to have a good idea of what your ultimate career goals are. I knew I was 80/20 leaning towards private vs academic, but wanted to at least give myself a fair shot to evaluate academia. Hence I went to an academic training program where I was required to publish and present at some national meetings. It was alright I guess, just not my jam.
- It's hard to figure out the true gist of a program on a short interview so utilize the current fellows. They have no reason to lie to you since they'll never work with you. It's also a small world of us. Somewhere around 3000 of us total in the US, so it benefits nobody to lie to you just to get you to come to a program if you're going to be miserable.


Hope this helps. It's rather vague-ish but only because each program is so different and similar in the same ways. Good luck guys. Cheers. If we ever get back to doing in person meetings again, hit me up, first round is on me. @LucidSplash and @Jolie South have agreed to pick up the tab after that with all the fat stacks of attending money they be making.

 

[LucidSplash]

Everything below is just an opinion so take it for what it's worth:

Where would you go for the best all-round general vascular/endovascular training?
- Almost every program will give you this. This isn't a cop out answer, but there are requirements to being a fellowship and so if it is an accredited program, then you're going to be fine for the most part.
- The other thing to consider is your own ability to pull from fellowship what you need in order to be successful. I've had attendings come from big name institutions and suck ass. I've also had those come from lesser name programs and just be absolutely slick. So although the name matters-ish, the more important thing is you and your ability to extract from those two years what you need in order to be successful in independent practice.

Where to go to learn open aortic stuff?
- Caveat: I'm gonna miss some. I just am. This in no way should be interpreted as disrespect.
- The usual suspects come to mind: Cleveland Clinic, U of Florida, UTSW, UPMC, Houston Methodist, Albany.
- The less known: U of Wisconsin, Pennsylvania (not UPenn), Colorado, NYU.

Where for complex endovascular stuff?
- Stanford, Mayo (not sure w/ Oderich leaving for UT Houston but I'm sure they'll continue to crank), UTSW, U of Washington, UNC. Basically anybody who has an IDE.

Any major regional differences to be aware of? I'm located in the West.
- I don't think so. Being on west coast will make it expensive and exhausting to travel to the east coast programs for interviews, although I have no idea how this will work now with COVID.

What would recommend for the senior GS resident to consider when applying? What informed your decision making?
- I think it's important to have a good idea of what your ultimate career goals are. I knew I was 80/20 leaning towards private vs academic, but wanted to at least give myself a fair shot to evaluate academia. Hence I went to an academic training program where I was required to publish and present at some national meetings. It was alright I guess, just not my jam.
- It's hard to figure out the true gist of a program on a short interview so utilize the current fellows. They have no reason to lie to you since they'll never work with you. It's also a small world of us. Somewhere around 3000 of us total in the US, so it benefits nobody to lie to you just to get you to come to a program if you're going to be miserable.


Hope this helps. It's rather vague-ish but only because each program is so different and similar in the same ways. Good luck guys. Cheers. If we ever get back to doing in person meetings again, hit me up, first round is on me. @LucidSplash and @Jolie South have agreed to pick up the tab after that with all the fat stacks of attending money they be making.

Hey @TypeADissection, thanks for picking up the slack here. I'm so sorry, I completely spaced on responding to this thread. My bad.

In general I agree with everything here. Would add that there are several "off the radar" places doing advanced endo for aortic disease. For example, Frank Arko is at Carolinas (used to be at Stanford) and does a fair amount of interesting work including dealing with coarctation in adults, both open and endo.

IMHO, I have found that unfortunately there is not a lot of overlap in places doing advanced open limb salvage (distal tibial and pedal bypasses) and advanced aortic endovascular. Not saying you can't find it, but for some reason a lot of places tend to focus on one or the other.

This is going to sound silly, but to get a better idea of who is doing what, join Twitter. Most of the major programs have an official account, and there are a lot of bigwigs at various places with their own accounts, and they frequently share interesting cases there. Anyone on Twitter is pretty open to being contacted for advice by a trainee, so its an interesting evolution that now you can slide into the DMs of some bigwigs and ask for career advice.

 

[LucidSplash]

Hope this helps. It's rather vague-ish but only because each program is so different and similar in the same ways. Good luck guys. Cheers. If we ever get back to doing in person meetings again, hit me up, first round is on me. @LucidSplash and @Jolie South have agreed to pick up the tab after that with all the fat stacks of attending money they be making.

Ha yes! Definitely!

 

[Jolie South]

I came from a fairly chill West Coast GS residency and ended up at a quasi academic high volume tertiary center for fellowship. I interviewed at a fair number of programs. There were places that I am sure are great but I didn’t vibe with. I knew I didn’t really want to do hard core academics and I hate research (like reading it but not writing it...lol).

Where you go probably matters more if you are interested in academia. I had no interest in being the big open aortic person or the complex aortic endo person. I did a ton of solid bread and butter cases from dialysis access to open aortic work. I think I went to a great program to train me to be a good general vascular surgeon.

If I have learned anything from being out of training, it’s that you can always learn more and you are never going to have done every case there is out there. Be that esoteric open cases or learning about new technologies and equipment. So fellowship isn’t the end all be all. I honestly feel I have learned more as an attending, but I think I am in an unusual circumstance (solo practice in a hospital with gap in vascular coverage). I have learned more about equipment and devices and purchasing and politics than I ever wanted to. But this isn’t about me. Haha


Bottom line:

Look for a program that matches your career goals.

Ask about open aortic numbers because according to my former program director there are a number of programs where the fellows got ZERO open aortic numbers. I don’t know where those places are but they are apparently out there.

Use faculty mentors to guide you in program selection. They will know reputations and what places are “known for.”

 

[TypeADissection]

Would add that there are several "off the radar" places doing advanced endo for aortic disease. For example, Frank Arko is at Carolinas (used to be at Stanford) and does a fair amount of interesting work including dealing with coarctation in adults, both open and endo.

Gonna piggyback off of this and completely agree. I really liked the Carolina program and Charlotte is an awesome city. EVMS should be mentioned because I don't think they get enough credit for how solid of a program they are w/ Jean Panneton at the helm. I have friends from both programs and they've all been well-trained.

If I have learned anything from being out of training, it’s that you can always learn more and you are never going to have done every case there is out there... Ask about open aortic numbers because according to my former program director there are a number of programs where the fellows got ZERO open aortic numbers. I don’t know where those places are but they are apparently out there.

I had heard at a conference that there were fellows recently who had graduated or were on track to graduate that had done less than 5 open aortas. I definitely think that is a travesty. The other thing to differentiate is how much of the case you're actually getting to do. There's a difference between doing the case where you're actually exposing the supraceliac/suprarenal/infrarenal aorta and watching your attending do it. There's a difference between actually sewing on the back wall for the proximal anastomosis or reimplanting the IMA and watching your attending do it. I did right around 45 open aortas in my fellowship but I know that I've done all of the exposure and anastomoses for at least 40 of those and probably the last 10 or so with just the general surgery resident. There's also a huge difference between doing an open aorta for aneurysmal versus occlusive disease. They really are very different operations.

Talking to buddies of mine who range between 1-3 years out of fellowship, they all say that you'll never do every case out there and you'll definitely have to do things that you've never done before in fellowship. But that's the other thing about fellowship, it's not just teaching you individual operations but rather a thought process. It's easy to have Plan A always work in fellowship because the attendings have a great Plan A. A lot of the feedback I've received from being a new attending is how often Plan A doesn't work and now you're reaching into your bag of tricks for Plans B and C. And that's just going to be experience and learning from your mistakes.

PS - I'm going to be starting as a brand new attending here shortly. Saw my name on the call schedule for September and immediately shat myself. Unfortunately, my new hospital doesn't have brown scrubs.

 

[ExtraAnatomical]

Im also in GS applying for Vascular this year and I can't find a whole lot of info about programs.
How are you all doing will LORs/personal statements and the remainder of the process?

 

[TypeADissection]

Im also in GS applying for Vascular this year and I can't find a whole lot of info about programs.
How are you all doing will LORs/personal statements and the remainder of the process?

If I remember correctly, the application opens right after Thanksgiving. So you have time. But now is the time to start planting the seeds of inception because my attendings were notoriously flight of ideas when it came down to writing these damn things. To prevent it being awkward, and something I learned from my days in finance, I always set a timetable upfront with my attendings on when I would follow up with them. That way it didn't come across as nagging if they hadn't done it yet. I also always set up a meeting with their secretary to sit down and go through the "why" I am doing this. That way neither party would feel rushed. Good luck.